Karaulov A V, Afanasiev S S, Zatevalov A M, Nesvizhsky Y V, Voropaeva E A, Afanasiev M S, Bondarenko N L, Mironov A Y, Borisova O Y, Urban Y N, Voropaev A D, Borisova A B
Ministry of Health and Social Development of the Russian Federation I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
G.N. Gabrichevsky Moscow Research Institute for Epidemiology and Microbiology, Moscow, Russia.
Klin Lab Diagn. 2020 Jun 4;65(7):443-453. doi: 10.18821/0869-2084-2020-65-7-443-453.
The aim of the work - to establish the interconnection and interdependence of toll-like mediated pathogenetic mechanisms of urogenital infection in pregnant women from the position of epigenomics. Using discriminant analysis in 89 patients with urogenital infection in pregnant women for the first time was established a reliable evidence-based relationship and interdependence between mucosal immunity, the severity of the infectious process, clinical manifestations, symptoms of miscarriage in the background of simultaneous development of the infectious process and pregnancy. For urgent delivery (infection), urgent childbirth (infection and clinical manifestation) and premature birth, mucosal immunity determines the severity of anti-infective resistance (with increasing mucosal immunity oppression of infectious process and clinical manifestations is logged , and its decrease increases the severity of infection process and clinical manifestations); the inhibition of mucosal immunity prevails over its hyperreaction (inhibition of mucosal immunity is determined by the physiological immunodepression in response to the development of pregnancy, as well as in response to herpes virus infection when activated); the severity of the infectious process depends on the severity of clinical manifestations and symptoms of miscarriage. During miscarriage mucosal immunity provides the pathophysiological course of infectious process and the clinical manifestations and development of symptoms of misacrriage; increasing levels of mucosal immunity to hyperreaction contributes to the development of symptoms of abortion and miscarriage; not registered mutual influence of oppression, mucosal immunity and its hyperreaction; the severity of the infectious process does not depend on the severity of clinical signs and symptoms of miscarriage. In urgent childbirth (infection), the oppression of mucosal immunity does not affect the severity of clinical manifestations, symptoms of abortion and the infectious process. In urgent or premature birth, and termination of pregnancy, the oppression of mucosal immunity affects the severity of clinical manifestations, the severity of the infectious process and the symptoms of abortion; the severity of clinical manifestations and the severity of the symptoms of abortion are interrelated. In urgent birth (infection) mucosal immunity overreaction affects the severity of clinical manifestations, symptoms of miscarriage and infection; in case of term and preterm labour overreaction mucosal immunity on the severity of infection and symptoms of abortion and does not affect the severity of clinical manifestations and at the termination of a pregnancy mucosal immunity on the severity of the infectious process and does not affect the severity of clinical signs and symptoms of abortion. The levels of mucosal immunity inhibition, its hyperreaction, clinical manifestations, symptoms of pregnancy termination and the severity of the infectious process do not depend on the type of herpes simplex virus. In the absence of infection with herpes simplex virus in patients with urogenital infections of pregnant women, there is no mutual influence and the relationship between the oppression of mucosal immunity and hyperreaction of mucosal immunity, the oppression of mucosal immunity prevails over its hyperreaction. With increasing mucosal immunity oppression, increased anti-infectious resistance of the body (the decreased activity of the infectious process), and with its decrease decreased (increased activity of the infectious process). Hyperreaction of mucosal immunity influenced the severity of pregnancy termination symptoms, clinical manifestations and infectious process, and also determined the severity of pregnancy termination symptoms. The severity of the infectious process and clinical manifestations influenced the symptoms of abortion. The severity of the infectious process did not affect the clinical manifestations. During infection with herpes simplex virus type I or type I and II on the background prevalence of oppression mucosal immunity over hyperreaction mucosal immunity, the presence of relationships between them, and the impact of mucosal immunity on the severity of the infectious process and the clinical manifestations increase mucosal immunity has been shown to decrease the severity of infection and clinical manifestations (reduction of anti-infective resistance), while reducing mucosal immunity the severity of infection and clinical manifestations increased. Hyperreaction of mucosal immunity influenced the severity of pregnancy termination symptoms and determined the severity of pregnancy termination symptoms. The severity of the infectious process and clinical manifestations influenced the symptoms of abortion. The severity of clinical manifestations reflects the severity of the infectious process. In type I and type II of pregnancy, the level of mucosal immunity determines the anti-infectious resistance of the body in urogenital infection of pregnant women. Inhibition of mucosal immunity and its hyperreactions are interrelated, have an impact on each other, as a result of their integral interaction, increasing the levels of mucosal immunity leads to a decrease in the severity of clinical manifestations and the infectious process, reducing the levels of mucosal immunity contributes to the manifestation of clinical manifestations, as well as increasing the severity of the infectious process. Hyperreaction of mucosal immunity affects the severity of symptoms of abortion, infection and clinical manifestations. The infectious process and clinical manifestations determine the severity of the symptoms of abortion. In type III and type IV of pregnancy course, there is no mutual influence of mucosal immunity oppression and its hyperreaction. The levels of indicators of mucosal immunity oppression and its hyperreaction are interrelated; the increase in the severity of mucosal immunity oppression is accompanied by a decrease in clinical manifestations and severity of the infectious process and vice versa. Hyperreaction of mucosal immunity affects the severity of symptoms of abortion, infection and clinical manifestations. The infectious process determines the severity of the symptoms of abortion and clinical manifestations, acting as a leading component of gestational complications in urogenital infection of pregnant women. In the III type of pregnancy course oppression of mucosal immunity does not affect the severity of symptoms of miscarriage. In the IV type of pregnancy course, the levels of mucosal immunity oppression prevail over the indicators of mucosal immunity hyperreaction, which is due to the integral interaction of physiological inhibition of immunological reactivity of the organism in response to pregnancy and inhibition of immunological reactivity of the organism, accompanying the activation of infectious process of viral genesis. Hyperreaction of mucosal immunity determines the symptoms of abortion.
这项工作的目的是从表观基因组学的角度确定孕妇泌尿生殖系统感染中Toll样受体介导的致病机制之间的相互联系和相互依存关系。通过对89例孕妇泌尿生殖系统感染患者进行判别分析,首次确定了黏膜免疫、感染过程的严重程度、临床表现、在感染过程与妊娠同时发生背景下的流产症状之间可靠的循证关系和相互依存关系。对于紧急分娩(感染)、紧急剖宫产(感染和临床表现)和早产,黏膜免疫决定抗感染抵抗力的严重程度(随着黏膜免疫增强,感染过程和临床表现受到抑制,而其降低则会增加感染过程和临床表现的严重程度);黏膜免疫的抑制作用强于其高反应性(黏膜免疫的抑制是由妊娠发育以及疱疹病毒感染激活时机体的生理性免疫抑制所决定的);感染过程的严重程度取决于临床表现和流产症状的严重程度。流产期间,黏膜免疫决定感染过程的病理生理进程、临床表现以及流产症状的发展;黏膜免疫水平升高至高反应性会导致流产和流产症状的发展;未发现黏膜免疫的抑制作用与其高反应性之间存在相互影响;感染过程的严重程度不取决于流产的临床体征和症状的严重程度。在紧急剖宫产(感染)时,黏膜免疫的抑制作用不影响临床表现、流产症状和感染过程的严重程度。在紧急或早产以及终止妊娠时,黏膜免疫的抑制作用会影响临床表现的严重程度、感染过程的严重程度和流产症状;临床表现的严重程度与流产症状的严重程度相互关联。在紧急分娩(感染)时,黏膜免疫的高反应性会影响临床表现、流产症状和感染的严重程度;在足月和早产时,黏膜免疫的高反应性对感染严重程度和流产症状有影响,但不影响临床表现的严重程度,而在终止妊娠时,黏膜免疫对感染过程的严重程度有影响,但不影响流产的临床体征和症状的严重程度。黏膜免疫抑制水平、其高反应性、临床表现、妊娠终止症状以及感染过程的严重程度不取决于单纯疱疹病毒的类型。在孕妇泌尿生殖系统感染患者未感染单纯疱疹病毒的情况下,黏膜免疫的抑制作用与其高反应性之间不存在相互影响和关系,黏膜免疫的抑制作用强于其高反应性。随着黏膜免疫抑制作用增强,机体的抗感染抵抗力增强(感染过程的活性降低),而其降低则会导致抵抗力下降(感染过程的活性增加)。黏膜免疫的高反应性影响妊娠终止症状的严重程度、临床表现和感染过程,也决定妊娠终止症状的严重程度。感染过程和临床表现影响流产症状。感染过程的严重程度不影响临床表现。在I型或I型和II型单纯疱疹病毒感染背景下,当黏膜免疫的抑制作用强于其高反应性时,它们之间存在关系,且黏膜免疫对感染过程的严重程度和临床表现有影响,研究表明,增强黏膜免疫可降低感染和临床表现的严重程度(抗感染抵抗力降低),而降低黏膜免疫则会增加感染和临床表现的严重程度。黏膜免疫的高反应性影响妊娠终止症状的严重程度并决定妊娠终止症状的严重程度。感染过程和临床表现影响流产症状。临床表现的严重程度反映感染过程的严重程度。在妊娠的I型和II型过程中,黏膜免疫水平决定孕妇泌尿生殖系统感染时机体的抗感染抵抗力。黏膜免疫的抑制作用与其高反应性相互关联、相互影响,由于它们的整体相互作用,增强黏膜免疫水平会导致临床表现和感染过程的严重程度降低,降低黏膜免疫水平则会导致临床表现显现,同时增加感染过程的严重程度。黏膜免疫的高反应性影响流产症状、感染和临床表现的严重程度。感染过程和临床表现决定流产症状的严重程度。在妊娠的III型和IV型过程中,黏膜免疫的抑制作用与其高反应性之间不存在相互影响。黏膜免疫抑制指标水平与其高反应性指标水平相互关联;黏膜免疫抑制作用严重程度增加会伴随着临床表现和感染过程严重程度的降低,反之亦然。黏膜免疫的高反应性影响流产症状、感染和临床表现的严重程度。感染过程决定流产症状和临床表现的严重程度,是孕妇泌尿生殖系统感染中妊娠并发症的主要组成部分。在妊娠的III型过程中,黏膜免疫的抑制作用不影响流产症状的严重程度。在妊娠的IV型过程中,黏膜免疫抑制指标水平高于黏膜免疫高反应性指标水平,这是由于机体对妊娠的生理性免疫反应抑制以及伴随病毒源性感染过程激活的机体免疫反应抑制的整体相互作用所致。黏膜免疫的高反应性决定流产症状。